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Latching and staying on!!!!

I delivered my baby boy at 37 weeks via Csection and he weighed 4.13 He dropped to 4.8 and as this past Monday he is up to 5lbs!!!!! I have been pumping and feeding him with a bottle and it has taken its toll on me mentally, physically and emotionally!!!!! I saw a LC about a week and a half ago and she told me that he was just to little to nurse at this time and suggested I come back in a couple weeks when he has gained some weight and a little older! She sent me home with a SNS, I have fumbled with that thing and ended up getting so frustrated with it that I threw it across the room!!! I am going back to see her today because I feel like he is ready to learn!!! He is more alert now and most of all I'm ready to stop pumping and feeding and just want to breast feed already!!! When I offer him, he is more than ready to take my boob, its just that he either doesnt latch on deep enough and seems to spit it out after a couple of sucks or he will latch on correctly sometimes and suckles and has a couple swallows, then jerks his head back and screams. We are also dealing with thrush. Im hoping today we can make progress toward EBF, so that him and I both can be happy!!!!! Any suggestions?!?!?!

Re: Latching and staying on!!!!

It sounds like you are doing really well, so my first suggestion is give your self a big pat on the back for bringing in a good milk supply even though your baby could not nurse.

My second suggestion is to get the facts but then follow your heart or instincts. Some tiny babies do have a difficult time latching, but others latch & nurse just fine. Breastfeeding advice is almost never one size fits all. You are the expert on your baby. If you think your baby is ready to latch and nurse at the breast, then feel free to work on that. Don’t wait for someone else’s permission. If the issue is baby is not able to get enough overall just nursing at the breast, you can try pumping and supplementing as necessary as well as nursing. But babies learn to breastfeed by breastfeeding, so the sooner and more often you can have baby nursing at the breast, the better, and nursing at the breast is also much easier on mom than exclusively pumping.

And, if you do still need to supplement, I would suggest still working with the sns (it may become easier once baby is latching-this is a tool for a baby who can nurse but needs some supplement.) But if that just does not work for you, you can try cup feeding (find video here: http://www.nbci.ca/index.php?option=...id=6&Itemid=13

Also what do you mean you are dealing with thrush? has that been diagnosed by the LC and are both you and baby being treated and how?

The jerking his head back & screaming could be because, after being bottle fed, he is frustrated the milk does not come as fast as the bottle (it won't, but this is when things like having some milk to dribble into his mouth to keep him happy or maybe breast compressions might help.)

Also try different nursing positions, some babies fuss at the breast because they are in what is for them, an uncomfortable position. Try Cross cradle, football, sidelying, and the various "laid back" aka biological nurturing positions-any may help. If you want more info on positioning let me know.

Re: Latching and staying on!!!!

Wow, I'm surprised that the LC suggested taking the baby off the breast! It's almost always easier to keep a baby on the breast, even if it's in a limited fashion, than to get him back to the breast after a break.

The behavior you describe- taking a couple sucks and then pulling off- is fairly typical for a baby who has gotten lots of bottles, and has come to expect and enjoy them. I think I would want to start by reviewing this link: http://www.kellymom.com/bf/concerns/...to-breast.html and trying the techniques mentioned in it, especially the skin-to-skin and instant reward techniques. You probably also want to take a look at this one: http://www.kellymom.com/bf/pumping/a...e-feeding.html. The techniques mentioned in the second link may help you combat any bottle preference your baby has developed. I personally suggest doing the following to help baby start to associate breast with food:
- when it's time to bottle feed, open your shirt and cuddle baby against your bare breast, to help him associate being held at the breast with eating
- use the slowest-flow bottle nipples possible
- pause the feeding frequently, to get baby used to the fast flow-slow flow rhythm of breastfeeding
- try the SNS again! I know it's frustrating, but it may be worth another try.
- try a nipple shield. Sometimes babies who like bottles also like shields, and that could help you transition back to the breast.

Re: Latching and staying on!!!!

My baby boy was diagnosed with thrush on Feb. 13th. The pediatrician gave him a script for Nystatin. We used that for a week. At his follow up appt. he still had some white spots on the insides of his cheeks so she gave him a script for Diflucan. We have been using Diflucan for 5 days now. I had some signs of thrush on my nipples and called my OB to get a script and they wouldn't give me one without seeing me and I have an appt on the 27th. (earliest they could get me in) I went for the 2nd time to see a LC on thursday the 23rd. This time I saw a different lady from before. She looked at my nipples and said they did look like they had a little bit of thrush on them, and suggested I just use APNO instead of genetian violet, since the baby has no signs of thrush now. This LC showed me how to use the SNS and gave me a nipple shield. He did great with the shield! When she evaluated his suck, she said that he was definitely used to taking a bottle! She suggested I use the SNS once a day, and bottle feed the rest and supplement with formula if I need to, because she said my supply was low. She told me to keep pumping 8 times a day, gave me "More Milk Plus" capsules (fenugreek, blessed thistle and nettle), told me to consider Domperidone, and follow up with her as needed. This business of LC'ing does not take insurance and is very expensive! I don't know if I will be able to go again, and I still feel like I'm not getting any thing out of it! I did rent a hospital grade pump from them, but my nipples and areola are so sore and sensitive still!!!!!! I am using the medium flanges after switching from the trying the large ones. Now my breasts are kinda sore all over. Don't know if it's from the massaging Im doing during the pumping or if I have clogged ducts or mastitis. I'm still confused on forceful letdown and slow letdown! I have read the links and still don't know if I have either one!!!! I'd really like to find out cause if I am haaving the forceful letdown, do I still need to try and increase my supply like the LC suggested??? I do struggle with positions!!!!! I started out using the football hold and the 1st LC told me to do the cross cradle hold. I also just ordered the CALMA nipple from Medela yesterday. I have been using the one time use red latex nipples that we got from the hospital and in the pre mixed similac boxes. I've tried the Slow flow medela and tommee tippee nipples and those still seem like they are to fast. He also prefers the red latex over the other silicone ones!

Re: Latching and staying on!!!!

I understand your confusion. I am confused as well!

Did you tell your LC that nursing is too painful right now and you would prefer to pump and bottle feed? Because if not, your LC advice is very odd, in my opinion. Sorry, they have seen you & your baby and I have not, and I really don't know what the conversation was that made them give the advice they are giving. But I utterly fail to understand why you are not being encouraged to nurse at the breast as much as possible! If baby latched great with the shield, then you should be nursing with the shield! Shields have their drawbacks, of course, but if baby cannot latch without it, it is far far better to nurse with a shield than to give bottles. You will likely need to pump as well due to the supply issues, even just using shields can make some pumping necessary. But that does not mean you pump instead of nursing, and you need not pump endlessly or a zillion times a day if baby is latching and nursing, it’s just for extra stimulation to insure a good supply, so if baby is nursing well and frequently, even with a shield, pump as much as you can but no need to go nuts with it. And if you do need to supplement, with your pumped milk or formula, you can certainly do so, at the breast, using the SNS! Why teach you to use an SNS and then tell you to supplement with bottles? If bottles are affecting the latch, why encourage more bottle use? I just do not get it!

I suggest you don't worry about forceful letdown or slow letdown at this point, that is the least of your concerns right now. Once you are nursing more the signs will be much more obvious to you.

Plugged ducts can usually be felt in the breast, anything from a small lump to a large hard area could be plugged milk ducts. The symptoms of mastitis are pretty clear-pain in the breasts, often a red spot or streaks, flu like symptoms (feeling run down, achy) and sometimes, fever.

engorgement can also make the breasts uncomfortable, that would be a heavy, tight, swollen feeling in the breasts.

Luckily the best treatment for all three-plugs, mastitis, and engorgement- are similar-keep the milk flowing, by nursing frequently, and, if that is not possible, by hand expression or pumping as needed. There are other things to do specific to each concern, but keeping the milk flowing out of the breast is number 1.

If massage seems to be exacerbating the issue, just stop massaging or change your technique. Too much rubbing at the breast could cause more inflammation. A gentle massage technique is the "bag of marbles" technique where you gently lift and move the entire breast around like you are playing with a bag of marbles.

Do you think you have thrush? Thrush causes pain in the nipples and sometimes, shooting pains in the breast, and usually makes the skin of the nipples or areolas appear shiny or flaky. It is frequently improperly diagnosed in mom, but babies symptoms are pretty clear, when present- often, however, baby has no symptoms. Thrush in baby is indicated by white patches in the mouth that turn red or bloody when lightly scratched. A whitenes just on the tongue is normal and does not indicate thrush.

No matter who has symptoms of thrush, you or your baby, you both need to be treated, at the same time, and Nystatin has been proven less effective than diflucan for both mom and baby. Even if a baby has no symptoms, if mom has thrush, baby must be treated as well! This is basic lactation advice, I am very surprised your LC had a different recommendation.

If you have thrush, I suggest insisting on seeing a doctor NOW. Thrush causes extreme pain and thus can be the end of breastfeeding and that is a major health issue for both you and your child. Ergh, I cannot stand how difficult it is to get proper medical treatment for these issues!

APNO is a good preventative and certainly you can use it along with the other treatments but it is unlikely to solve full blown thrush, IMO. If thrush could be cured with a topical application of an anti-fungal treating thrush would be very simple. Unfortunately, it usually cannot.

Do you have La Leche League in your area? I would really like it if you could call a local Leader or go to a meeting. You need support and some help sorting through all the confusing advice you have been given. Actually you can call any Leader, anywhere, as many as you like and as much as you like and we are free.
And trust your instincts!

Re: Latching and staying on!!!!

I actually called a LLL leader in my area when we 1st got home from the hospital. She suggested I see a LC and sent me links to the LC business I have been seeing! I was shocked!!!! My county does not have LLL, and she was from one of my neighboring counties thats only 10 minutes away. The place she suggested is 30-40 away from my house!!! By no means did I ever remotely indicate to the LC that I wanted to bottle feed!!!!! Me wanting to get him to the breast was the main reason I went a 2nd time!!!!! She seemed more concerned with his weight, than trying to get him to bf!!!!! I am gonna look up some more LLL and contact one asap!!!! Thanks for all your help!!!! I wish you were in Kentucky!!!!!!! Could anyone recommend a LLL in the Louisville, Ky area?????

Re: Latching and staying on!!!!

Not all Leaders are able to do home visits, but chatting on the phone may help a lot as would going to a meeting. You can also call the LLL USA helpline, they have been swamped as of late so it can take a day or two to get a call back (it's really bad on weekends, although as of last night the line was only backed up about 5 calls today which is not bad) but the Leaders on there are often very good as they talk to moms from all over, all the time, & have heard it all.

Leaders often suggest moms consider seeing a board certified lactation consultant at the Leader’s discretion, when she thinks the situation warrants that. Although, if possible, it is best if the Leader can suggest at least 2 or 3 local IBCLCs and encourage the mom to call them all and figure out which one sounds best to her, we are not supposed to recommend particular IBCLCs. I have given moms names of IBCLCs when I thought an issue was beyond my expertise, or they needed hands on help right away I could not provide, which may have been the case when you first brought baby home & weight was such a huge concern. But I never mean for that to be the end of my help, and I always ask the mom to please call me back with updates or more questions. Perhaps the Leader you called felt the same way. But the situation is different now, I assume baby is gaining and all that is more or less under control now, so, your main issue now, as I understand it, is getting help getting baby to the breast and learning how to feel confident baby is getting enough at the breast and what to do if baby is not. This is something a Leader should certainly be able to help you with.

I would also suggest you consider calling back the LC. Different LCs will have different policies about payment but in my experience, follow up calls for clarification and/or about the same issues are considered included in the original appointment cost. Sometimes what an LC (or a Leader) thinks they have said is not what the mom hears, (and vice versa) and they appreciate knowing when a mom is not happy with the appointment or conversation. I cannot speak for all IBCLCs of course, and there are some I think are not very good, but many of my acquaintance are in the biz to sincerely to help moms and babies (certainly, its not to get rich) and will work with the mom to find the solutions that work for HER. You could explain your confusion and disappointment with not being helped with what you want to work on, maybe you could even get another appt for free to work only on latch.

Ultimately, although outside help certainly can help, breastfeeding is so personal an art, each mom needs to figure much of this stuff out on her own, with her baby. You are very determined and you are learning your baby more and more everyday. You are the expert on your baby, and I really think you will be fine, I think you have been pulled in a million directions with maybe too much information/instructions and you are thus not trusting your own instincts.

In pps you have said baby can latch, and baby latches even better with a nipple shield. So I suggest you start with that, encouraging baby to latch, & nurse, as much as you can. Keep baby on you, with easy access to the breast, as much as possible, and any time baby makes any show of rooting, or any cues, help baby find the nipple. If you think baby is not getting enough, try supplementing with the sns as much as you like, your pumped milk when you can, formula if necessary. Pump as you can, pumping sessions can be short and at irregular intervals, that is FINE. As long as a baby can latch and transfer milk at the breast, you want to fit pumping around the nursing, not the other way around.

Good resources for self help: Books: The Womanly Art of Breastfeeding (8th edition) and
Making More Milk